Review the PAD, document the clinical contraindication to olanzapine, select an alternative medication that is as consistent with the patient's expressed preferences as possible (avoiding haloperidol unless no reasonable alternative exists), consult the treatment team, and document the rationale for any deviation from the PAD.
This is correct. When a PAD's specific instructions become clinically impractical, the PMHNP should honor the spirit of the directive rather than abandoning it entirely. The patient requested olanzapine (an atypical antipsychotic) and specifically refused haloperidol (a typical antipsychotic). The PMHNP should select an alternative atypical antipsychotic that is clinically appropriate and consistent with the patient's apparent preference for atypical over typical antipsychotics. The entire decision-making process should be documented, including the contraindication, the alternatives considered, and the rationale for the final selection.